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首页> 外文期刊>Surgical oncology >Esophageal cancer: patient evaluation and pre-treatment staging.
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Esophageal cancer: patient evaluation and pre-treatment staging.

机译：食道癌：患者评估和治疗前分期。

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Improvements in the overall survival of patients with esophageal cancer can in the future only be achieved by tailored therapeutic strategies which are based on the individual histologic tumor type, tumor location, tumor stage at the time of presentation, consideration of established prognostic factors and the physiologic status of the patient. The major aim of every diagnostic strategy is to assess whether a complete macroscopic and microscopic tumor resection (i.e. an R0 resection) can be achieved by primary surgical approach with a high degree of likelihood. This requires histologic classification of the tumor type (squamous cell cancer or adenocarcinoma), the exclusion of distant solid organ metastases, localization of the primary tumor in relation to the tracheobronchial tree, and determination of the T-category and the surrounding structures of the primary tumor. This is currently achieved by a combination of contrast radiography, endoscopy with biopsy, endoscopic ultrasonography and CT scan. PET scanning will in the future be more widely used in esophageal cancer staging because it appears to be superior to current imaging modalities in the exclusion of distant solid organ and lymph node metastases and allows early assessment of response of the primary tumor to neoadjuvant treatment. Systematic risk analysis with a dedicated composite scoring system is essential to assess the physiologic status of the patient and reduce postoperative mortality. Only hospitals with a sufficient case load of esophageal cancer patients ('hospital volume') and a dedicated interest in the management of this disease ('centers of excellence') can provide the required expertise and standards for patient evaluation and tailored therapy.
机译：食道癌患者总体生存的改善将来只能通过基于个体组织学肿瘤类型，肿瘤位置，出现时的肿瘤分期，已确定的预后因素和生理学的量身定制的治疗策略来实现患者的状态。每种诊断策略的主要目的是评估是否可以通过一级手术方法以很高的可能性实现完整的宏观和微观肿瘤切除（即R0切除）。这需要对肿瘤类型（鳞状细胞癌或腺癌）进行组织学分类，排除远处的实体器官转移，相对于气管支气管树的原发肿瘤定位以及确定T类别和原发灶周围结构瘤。目前，这是通过造影造影，内镜活检，内镜超声检查和CT扫描相结合来实现的。将来，PET扫描将在食道癌分期中得到更广泛的应用，因为在排除远处的实体器官和淋巴结转移方面，PET扫描似乎优于当前的影像学检查方法，并且可以早期评估原发肿瘤对新辅助治疗的反应。具有专用复合评分系统的系统风险分析对于评估患者的生理状况并降低术后死亡率至关重要。只有具有足够的食管癌患者病例量（“医院容量”）并且对这种疾病的治疗有浓厚兴趣（“卓越中心”）的医院才能为患者评估和量身定制的治疗提供所需的专业知识和标准。

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